Best Practices for Environmental Cleaning in Healthcare ...

VERSION 2

Best Practices for

Environmental Cleaning in Healthcare Facilities:

in Resource-Limited Settings

CS314156-A

Division of Healthcare Quality Promotion

This document provides guidance on best practices for environmental cleaning procedures and programs in healthcare facilities in resource-limited settings. It was developed as a collaboration between the Centers for Disease Control and Prevention (CDC) and the Infection Control Africa Network (ICAN). Best Practices for Environmental Cleaning in Healthcare Facilities in Resource-Limited Settings is a publication of the Division of Healthcare Quality Promotion in the National Center for Emerging and Zoonotic Infectious Diseases within CDC and the Education Working Group of the Infection Control Africa Network. Centers for Disease Control and Prevention Robert Redfield, MD, Director National Center for Emerging and Zoonotic Infectious Diseases Rima Khabbaz, MD, Director Division of Healthcare Quality Promotion Denise Cardo, MD, Director Infection Control Africa Network Sade Ogunsola, PhD, Chair Education Working Group Shaheen Mehtar, MBBS, Chair (Past Chair ICAN) Photo Credit: Cover page photo features Ms. De Bruin, a dedicated and passionate environmental cleaning staff member for over 40 years at a hospital in Cape Town, South Africa.

Suggested citation: CDC and ICAN. Best Practices for Environmental Cleaning in Healthcare Facilities in Resource-Limited Settings. Atlanta, GA: US Department of Health and Human Services, CDC; Cape Town, South Africa: Infection Control Africa Network; 2019. Available at: and

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Acknowledgements

Overall coordination and writing of the best practices: Molly Patrick (International Infection Control Program, Division of Healthcare Quality Promotion, CDC, Atlanta, Georgia, USA) jointly coordinated the development and led the writing of the best practices. Shaheen Mehtar (Education Working Group, Infection Control Africa Network, Cape Town, South Africa) jointly coordinated the development and contributed significantly to the structure and content of the best practices. Danielle Carter, Joyce Thomas and Sonya Arundar (Division of Healthcare Quality Promotion, CDC) provided professional editing (plain language and usability) assistance.

Expert Committee: The following experts participated in technical consultations to guide the development and provided technical review of the best practices: Benedetta Allegranzi, Nathalie Tremblay (Department of Service Delivery and Safety, World Health Organization (WHO), Switzerland); Margaret Montgomery (Water, Sanitation, Hygiene and Health Unit, WHO, Switzerland); Claire Kilpatrick (Soapbox Collaborative, UK); Joost Hopman (Consultant Microbiologist, Radboud University Medical Center, The Netherlands); Nkwan Jacob Gobte (Infection Control Africa Network, Cameroon); Matt Arduino, Michael Bell, Bryan Christensen, Denise Kirley, Cliff McDonald, Sujan Reddy, Rachel Smith, Amy Valderrama (Division of Healthcare Quality Promotion, CDC).

External Peer Review Group: The following experts provided technical expertise on infection prevention and control (IPC) in resource-limited settings: Nizam Damani (IPC Consultant, WHO and Southern Health & Social Care Trust, UK); Briette du Toit (Infection Prevention and Control Officer, Mediclinic Southern Africa, South Africa); Nagwa Khamis (CEO Consultant and Head of IPC Department, Children Cancer Hospital of Egypt, Egypt); Linus Kirimi Ndegwa (Program Manager, IPC/AMR, Division of Global Health Protection, CDC and IPNET-K Secretary General, Kenya); Robert M Njee (Senior Research Scientist, National Institute for Medical Research, Tanzania); Marcelyn Magwenzi (Microbiologist/ IPC Trainer, Infection Control Association of Zimbabwe, Zimbabwe); Ana Maruta (IPC Team Lead, WHO, Sierra Leone); Apurba S Sastry (Infection Control Officer, Antimicrobial Stewardship Lead, Associate Professor of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, India); Yolanda Van Zyl (Infection Control Practitioner/Chairperson Infection Control Society South Africa, Paarl Hospital, Western Capt Department of Health, South Africa).

Best Practices for Environmental Cleaning in Healthcare Facilities in Resource-Limited Settings | iii

TABLE OF CONTENTS

Acknowledgements iii ........................................................................................................................................................................................................... Abbreviations viii ............................................................................................................................................................................................................................. Key definitions 1 .............................................................................................................................................................................................................................. Icon Legends 4 ...................................................................................................................................................................................................................................

1. Introduction 5 ....................................................................................................................................................................................................................................... 1.1 Environmental transmission of HAIs 5 ............................................................................................................................................................. 1.2 Environmental cleaning and IPC 6 ...................................................................................................................................................................... 1.3 Environmental cleaning and WASH infrastructure 7 ........................................................................................................................... 1.4 Basis and evidence for proposed best practices 8 .............................................................................................................................. 1.5 Purpose and scope of the document 8 .......................................................................................................................................................... 1.6 Intended audience of the document 9 ............................................................................................................................................................ 1.7 Overview of the document 9 ....................................................................................................................................................................................

2. Cleaning Programs 11 ................................................................................................................................................................................................................. 2.1 Organizational elements 12 ..................................................................................................................................................................................... 2.1.1 Administrative support 12 .................................................................................................................................................................... 2.1.2 Communication 13 ..................................................................................................................................................................................... 2.1.3 Management and supervision 14 .................................................................................................................................................. 2.2 Staffing elements 15 ...................................................................................................................................................................................................... 2.2.1 Staffing levels 15 .......................................................................................................................................................................................... 2.2.2 Training and education 16 .................................................................................................................................................................... 2.3 Supporting infrastructure and supply elements 17 ............................................................................................................................. 2.3.1 Designated space 17 ................................................................................................................................................................................ 2.3.2 Water and wastewater services 17 .............................................................................................................................................. 2.3.3 Supplies and equipment procurement and management 19 ................................................................................ 2.3.4 Finishes, furnishings and other considerations 19 ......................................................................................................... 2.4 Policies and procedural elements 20 .............................................................................................................................................................. 2.4.1 Cleaning policies 20 .................................................................................................................................................................................. 2.4.2 Standard operating procedure 21 ................................................................................................................................................. 2.4.3 Cleaning checklists, logs, and job aids 22 .............................................................................................................................

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